Sunday, June 30, 2013

Your name has been called in the doctor's office. You take a seat, roll up your sleeve, stick your arm in a cuff, squeeze, and then a nurse or doctor reads your blood pressure. It's been done this way for years.
But a growing number of medical experts say that doctors' office blood-pressure readings can be flawed when it comes to diagnosing hypertension, an often symptomless condition that affects a third of adults, and is a major risk factor for heart attack, stroke and kidney disease. According to the American Heart Association, about 20 percent of patients experience "white-coat hypertension" — high blood pressure in the doctor's office due to the anxiety of being examined. Another 30 percent may experience "masked hypertension," blood pressure readings that are normal in the doctor's office, but high during the rest of the day.
"You can't make a decision to commit someone to taking a lifetime of blood pressure medications without having good data," said Dr. David Landers, a cardiologist at Hackensack University Medical Center. "One blood pressure reading in the office is not useful. What you need is more data points."
Some doctors maintain these two devices are better at tracking hypertension: home blood pressure monitors, which have become more affordable (about $45) and accurate in recent years; and an ambulatory blood pressure monitor (ABPM), a cigarette-pack sized device worn by patients for 24 hours and prescribed by their doctors. Fitted with a microchip, it automatically records blood pressure at regular intervals.
In the United Kingdom, ABPMs are routinely used. Anyone suspected of having high blood pressure is ordered to wear an ABPM before going on medication, as recommended by the national health service. In the United States, on the other hand, ABPM is not considered standard care and thus, according to Dr. David Wild, a cardiologist at Holy Name Medical Center in Teaneck, health insurance providers won't always cover it. Medicare will cover ABPM, but only if it's suspected a patient has "white coat hypertension."
Some doctors maintain ABPM is best. By wearing it for 24 hours, patients can have their sleeping blood pressure recorded, which for a small segment of the population may be critical. On average, a person's blood pressure dips by about 10 to 20 percent during sleep. But for some this dipping does not occur, and recent studies show that this group is at very high risk for heart attack or stroke, according to Dr. Craig Bowron, a Minneapolis-based internist and medical writer.
For those already being treated for hypertension, ABPM can also be useful in monitoring how well blood pressure medicines are working throughout the day, Boron said. With this information, a doctor may want to adjust the dosage or, depending on their daily blood pressure variances, even the time a patient takes his/her medication.
"We may be misdiagnosing patients," said Wild. "We should be doing more ABPM. It's the most accurate way to diagnose hypertension."
For Landers, a home blood monitor is good enough. "It's more user-friendly," he said. Though home monitors can become obsessive. "They can make people neurotic," said Bowron, "the same way people follow the stock market's ups and downs in a day."

Twenty thousand physicians in four Midwest states received a glimpse into their financial future last month. Landing in their e-mail inboxes were links to reports from Medicare showing the amount their patients cost on average as well as the quality of the care they provided. The reports also showed how Medicare spending on each doctor's patients compared to their local peers in Kansas, Iowa, Missouri and Nebraska.

The "resource use" reports, which Medicare plans to eventually provide to doctors nationwide, are one of the most visible phases of the government's effort to figure out how to enact a complex, delicate and little-noticed provision of the 2010 health care law: paying more to doctors who provide quality care at lower cost to Medicare, and reducing payments to physicians who run up Medicare's costs without better results.

Making providers routinely pay attention to cost and quality is widely viewed as crucial if the country is going to rein in its health care spending, which amounts to more than $2.5 trillion a year. It's also key to keeping Medicare solvent. Efforts have already begun to change the way Medicare pays hospitals, physicians and other providers who agree to work together in new alliances known as "accountable care organizations." This fall, the federal health program for 47 million seniors and disabled people also is adjusting hospital payments based on quality of care, and it plans to take cost into account as early as next year.

But applying these same precepts to doctors is much more difficult, experts agree. Doctors see far fewer patients than do hospitals, so making statistically accurate assessments of doctors' care is much harder. Comparing specialists is tricky, since some focus on particular kinds of patients that tend to be more costly.

Plus, properly assessing how a doctor affects costs must include not just the specific services she directly provides, but also care other providers may give, either because the patient was referred to them or because the original doctor didn't take the right preventive steps to avoid more expensive treatments later on. And without properly adjusting for patients' health problems, paying bonuses to physicians who use fewer Medicare resources might encourage doctors to stint on care or shun patients with expensive-to-treat ailments.

"It may be the most difficult measurement challenge in the whole world of value-based purchasing," said Dr. Donald Berwick, the former administrator of the federal Centers for Medicare & Medicaid Services, or CMS. "We do have to be cautious in this case. It could lead to levels of gaming and misunderstanding and incorrect signals to physicians that might not be best for everyone."

Dr. Michael Kitchell, a neurologist and chairman of the board at the McFarland Clinic in Ames, Iowa, one of the state's biggest multi-specialist practices, predicted the Medicare reports "will be a huge surprise to almost every physician." That's because the calculations of how much those doctors' patients cost Medicare include not just the services of the individual doctor but of all the doctors that provided any treatment to the patient. Kitchell said his own patients saw on average 13 other physicians besides himself.

"You're a victim or a beneficiary of your medical neighborhood," Kitchell said. "If the primary care doctors are doing the preventative screening tests, you'll get credit for that, but if you're in a community where the community doctors are doing a poor job, you're going to look bad."

Medicare officials are trying to refine the way they judge doctors as they follow the health care law's directive to phase in the new payment system, called a Physician Value-Based Payment Modifier, starting in 2015. It will initially apply only to physician groups and some specialists selected by the government, but by 2017 the payment change is supposed to apply to most if not all doctors.

The assessment "is a very important change we're putting into place, one where we're going to need a lot of feedback and deliberation," said Jonathan Blum, CMS's deputy administrator. "We're not blind to the challenges that are coming toward us."

Although the program is still being devised, it will become reality for many doctors starting in January, because CMS plans to base the 2015 bonuses or penalties on what happens to a doctor's patients during 2013.

As the nation's biggest insurer, Medicare's adoption of this approach would be "a game changer" in terms of making physicians directly accountable for costs, said Anders Gilberg, senior vice president at the Medical Group Management Association, which represents physicians groups. Medicare is "going to be shifting money from … physicians who are deemed to be high cost relative to their peers to low-cost physicians. That's going to create all kinds of new incentives in fee-for-service."

Private insurers may follow Medicare's lead, said Paul Ginsburg, president of the Center for Studying Health System Change, a Washington think tank. The formula Medicare ultimately designs to judge and pay doctors, Ginsburg said, could become "a valuable asset for private insurers, with a tool that will be somewhat bulletproof, that physicians won't attack because they've been part of the process of developing them."

But getting physician support may not be so easy, said Margaret O'Kane, president of the National Committee for Quality Assurance, a nonprofit in Washington. "Doctors are a very powerful political segment," she said. In addition, she added, "Patients are not behind this agenda. The public is very scared about managing costs."

In the reports, Medicare measures the average payments it made for each doctor’s patients, as well as subgroups of patients with common chronic conditions, such as chronic obstructive pulmonary disease, diabetes and heart failure. Medicare adjusts the costs to take into account differences in patients' age, gender, poverty and history of medical conditions.

For the resource reports, CMS has come up with a preliminary method to determine how central a role a doctor played in a patient’s care. If a doctor was responsible for at least 35 percent of a patient’s evaluation and management services, they are presumed to have "directed" the beneficiary’s care. If they didn’t direct the care but accounted for at least 20 percent of the physician fees billed for the beneficiary, they are considered to have "influenced" the care. And if they did less than that, they are considered to have "contributed" to the care.

But that method is widely considered so crude that few expect CMS will ultimately use it in payment. CMS is trying to develop more refined methods to compare physicians’ parsimony or extravagance with Medicare dollars using software programs called "episode groupers." These programs determine the combined cost for all the services—including doctors, labs, hospitals and pharmaceuticals—that were used to treat a distinct medical situation, such as urinary tract infection or hypertension attack, over a set period of time.

Initially, Medicare attempted to use existing programs devised by commercial insurers but found they didn’t work with Medicare data, according to a report from the General Accounting Office. "It is not clear that all the problems identified with the commercial groupers can be solved by a Medicare specific grouper and the timeline for its development is challenging," the report said.

Dana Gelb Safran, who oversees quality measurement for Blue Cross Blue Shield of Massachusetts, says she doubts it will be possible for the government to judge individual doctors. She predicts CMS will ultimately have to find ways to evaluate doctors as parts of groups- either formal affiliations as part of group practices or informal affiliations among doctors who refer to each other.

"There really are very few measures that we can reliably evaluate on the individual doctor level," she said. "When they move forward with the value-based modifier, there is going to have to somehow allow physicians to identify other physicians with whom they say they practice and who they say they share clinical risk for performance."

As of the end of April, the federal government has paid out $14.6 billion in EHR incentive payments, according to Robert Anthony, deputy director of the HIT Initiative Group at the Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services.
At the Health IT Policy Committee meeting on Wednesday, Anthony said the numbers were the most current available and show an increasing number of providers are interested in the program. There were 395,000 eligible providers and hospitals in “active registration” in the federal meaningful use program--out of a total pool of 532,000.
Though Medicaid providers lag behind Medicare providers in the program, CMS is encouraged by the steady increase in Medicaid eligible providers signing up to participate. To date, there are some 13,000 Medicaid meaningful users. “We’re seeing more and more come in month-to-month,” Anthony said. “In April, 3,200 came in and demonstrated meaningful use.”
Anthony said CMS is seeing an upward trend of meaningful users — both Medicaid and Medicare — who are not in primary care. Currently, 61 percent are in specialty care.
The numbers are slightly lagging behind those paid out a year ago at this time, but this relates to the fiscal year when certain providers are able to attest according to the program, Anthony said. “We will likely see more eligible providers and hospitals come in after the close of the fiscal year (October 1),” he said.
According to the latest data, a little more than 77 percent of hospitals have been paid under the program, and registration for eligible providers continues “pretty handily” at 75 percent, Anthony said. Three out of every four four eligible hospitals have made a financial commitment to an electronic health record, he said.
Also, according to Anthony:

Approximately 50 percent or one out of every two Medicare EPs are meaningful users of EHRs

Approximately 63 percent of all Medicaid EPs have received an EHR incentive payment

10 percent of Medicaid EPs are meaningful users

More than 55 percent – one out of every two Medicare and Medicaid EPs have made a financial commitment to an EHR.

More than 292,000 Medicare and Medicaid eligible providers have received an EHR incentive payment as of the end of April. Not all EPs are new, some are returning from a previous year, Anthony said. “Depending on how the numbers come together, we believe we’ll surpass 300,000 unique providers paid under the program, by the end of May.”
CMS analysis, with data through April, showed 194,080 eligible providers had attested: 193,867 successfully and 213 unsuccessfully. Some 2,977 hospitals had attested, all successfully, Anthony reported.

Saturday, June 29, 2013

BY JAY WEAVER

A top executive and three aides who prosecutors say operated a Hollywood psychiatric hospital like a “brothel of fraud” were found guilty Friday of bilking Medicare by submitting false claims for $67 million.

The taxpayer-funded healthcare program was duped into paying almost $40 million to Hollywood Pavilion, whose chief executive officer and others covered up the “sham” by falsifying patient records and marketing contracts with “dirty” patient recruiters, according to Justice Department prosecutors. The recruiters, many convicted felons, were paid more than $1 million for the patient referrals, prosecutors said.

The jury, which began deliberations Wednesday, found them guilty of conspiracy, healthcare fraud, wire fraud and kickback offenses. Petrie was the only defendant acquitted of any charges, namely two wire fraud counts.

All four defendants face potentially lengthy sentencings Sept. 10 before U.S. District Judge Jose Martinez.

A fifth defendant, Gloria Himmons, an Alabama patient broker, pleaded guilty in March to conspiracy and kickback offenses for receiving payments from Hollywood Pavilion for referring Medicare patients with alcohol or drug addictions who did not suffer from mental illness.

“Its whole business model was built on crooked doctors and patient recruiters who brought them patients,” prosecutor Robert Zink told the jury during closing arguments Wednesday. “The defendants would have you believe these criminals pulled the wool over their eyes.”

Attorneys representing the four defendants, who were on trial since mid-May, argued their clients never knowingly broke U.S. healthcare laws over the past decade, maintaining they acted lawfully in their dealings with doctors, patient recruiters and Medicare patients.

“You have a case that doesn’t make sense when you put it all together,” argued defense attorney Bruce Zimet, who represented Petrie, the outpatient director.

“She was not a member of a ‘brothel of fraud,’ ’’ Zimet told the jurors Wednesday. “She was a member of a club that wanted to help people.”

The prosecution of Hollywood Pavilion’s executives was the latest crackdown by the Justice Department and U.S. attorney’s office against operators of mental health facilities accused of bilking the Medicare program for the elderly and disabled.

Three previous major prosecutions led to the convictions of about 80 clinic operators, doctors, therapists and patient recruiters at American Therapeutic, Biscayne Milieu and Health Care Solutions Network in South Florida.

Eight of those convicted defendants testified at the Hollywood Pavilion trial, including Dr. Alan Gumer, a former medical director at the Hollywood Pavilion facility who is facing sentencing in August for his crime in the American Therapeutic case, and Keith Humes, a Hollywood Pavilion patient recruiter who is serving a seven-year prison sentence stemming from another Medicare fraud offense.

Zink, the Justice Department prosecutor, noted that Gumer signed off on medical charts for ineligible patients to make the paperwork look like he and other doctors had seen and treated them, when they had not.

Zink said Gumer had $500,000 in gambling debts and had not paid any taxes for years when he was working for Hollywood Pavilion. “He was a weak man,” Zink said, “who was willing to sell his license for money.”

The prosecutor described Humes as a career criminal who was paid more than $400,000 by Hollywood Pavilion’s CEO, Kallen-Zury, for purported “marketing services” to the company. Zink called that contract a “cover-up.”

“She knew it was a crime,” Zink said. “She paid for it, and she admitted it.”

On the witness stand, Kallen-Zury testified about her company’s relationship with Humes and other patient recruiters: “Referrals were my business,” Kallen-Zury said.

Her defense attorney, Michael Pasano, argued that she believed she was following Medicare policy and that her company’s payments to Humes and others were lawful.

Pasano described his client as a hard-working woman who took over the 40-year-old Hollywood Pavilion business from her father, and has lived an honorable life catering to women and men with psychological illnesses, such as schizophrenia and bipolar disorders.

In closing, Zink told the jurors a starkly different story, saying that Kallen-Zury and the other defendants exploited vulnerable patients who did not qualify for or actually need psychotherapy treatments under Medicare. As a result, Medicare, a program built on trust, was fleeced for millions, he said.

WASHINGTON – A federal jury today convicted four individuals for their participation in a Medicare fraud scheme involving nearly $70 million in fraudulent billings by Hollywood Pavilion (HP), a mental health care hospital.

Today’s verdict was announced by Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; United States Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the United States Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

Karen Kallen-Zury, 59, of Lighthouse Point, Fla ., and Daisy Miller, 44, of Hollywood, Fla ., were each found guilty of one count of conspiracy to commit wire fraud and health care fraud, five substantive counts of wire fraud and two substantive counts of health care fraud. Michele Petrie, 64, of Ft. Lauderdale, Fla ., was found guilty of one count of conspiracy to commit wire fraud and health care fraud and three substantive counts of wire fraud. Kallen-Zury, Miller, Petrie and a fourth defendant, Christian Coloma, 49, of Miami Beach, Fla ., were also convicted of one count of conspiracy to pay bribes in connection with Medicare, with Kallen-Zury and Coloma also each being convicted on five substantive counts of paying bribes.

“The defendants convicted today participated in a massive scheme that attempted to defraud the United States of approximately $70 million by taking advantage of Medicare beneficiaries,” said Acting Assistant Attorney General Raman. “By paying bribes to a network of patient recruiters and falsifying documents, the defendants created the illusion of providing intensive psychiatric care to qualifying patients, when in reality they provided no care of substance. Today’s verdict illustrates the success of the inter-agency Medicare Fraud Strike Force, which is dedicated to stamping out Medicare fraud.”

The defendants were charged in an indictment returned on October 2, 2012. Evidence at trial demonstrated that the defendants and their co-conspirators caused the submission of false and fraudulent claims to Medicare through HP, a state-licensed psychiatric hospital located in Hollywood that purportedly provided, among other things, inpatient psychiatric care and intensive outpatient psychiatric care. The defendants paid illegal bribes and kickbacks to patient brokers in order to obtain Medicare beneficiaries as patients at HP who did not qualify for psychiatric treatment. The defendants then submitted claims to Medicare for those patients who were procured through bribes and kickbacks.

Karen Kallen-Zury, the CEO and registered agent of HP, attempted to conceal the payment of bribes and kickbacks by creating false documents to make it appear as if legitimate services were being rendered.

Evidence at trial established that Miller, the clinical director of HP’s inpatient facility, and Petrie, the head of HP’s intensive outpatient program, facilitated the payment of bribes to patient recruiters and oversaw the fraudulent admissions and treatment of unqualified patients.

Trial evidence also demonstrated that Coloma, the director of physical therapy for an entity associated with HP, facilitated the payment of bribes and kickbacks, and he supervised the creation of false documents to conceal the bribery scheme.

From at least 2003 through at least August 2012, HP billed Medicare nearly $70 million for services that were not properly rendered, for patients that did not qualify for the services being billed and for claims for patients who were procured through bribes and kickbacks.

The criminal case is being prosecuted by Trial Attorneys Robert A. Zink, Andrew H. Warren and Anne McNamara of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the United States Attorney’s Office for the Southern District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

Healthcare industry-defining model to improve patient outcomes and reduce costs through new technologies, operational planning, support and consulting services

Long term alliance will support multiple GRMC sites, including its combined 632-bed medical center, cancer center, and children's hospital, with an order value of approximately USD 300 million

Andover, MA and Augusta, GA - Royal Philips (NYSE: PHG, AEX: PHIA) and Georgia Regents Medical Center (GRMC), Georgia's public academic health center renowned for its top-ranked doctors, today announced a 15-year alliance to enable increasingly patient-centered approaches to care and to create an innovative business model that addresses current and future clinical, operational and equipment needs of GRMC's multiple sites.

The alliance is a first-of-its-kind delivery model in the United States. Through the agreement, worth approximately USD 300 million, the largest of its kind for Philips, the company will provide GRMC with a comprehensive range of consulting services, advanced medical technologies, and operational performance, planning and maintenance services with pre-determined monthly operational costs over a 15-year term.

The alliance will broadly support the Georgia Regents Medical Center, Children's Hospital of Georgia, Georgia Regents University Cancer Center and the health system's numerous outpatient clinics, which serve the medical needs of four to six million people, across Georgia and South Carolina. Philips and Georgia Regents will work closely to deliver faster, more effective and cost-efficient care from diagnostics to therapeutics, and inpatient and outpatient clinical services. The alliance will impact all care areas, including radiology, cardiology, neurology, oncology and pediatrics, and enhance medical research and clinical technology R&D initiatives for care delivery innovation.

The agreement encompasses Philips imaging systems, patient monitoring and clinical informatics solutions, as well as lighting and consumer products. Philips will also furnish GRMC rapid access to new equipment as well as educational resources. Philips and GRMC will work together to cost-effectively design and deploy innovative patient care strategies.

"By collaborating with Philips, we're bringing all the stakeholders together at the same table to better assess and plan health care for tomorrow. It's no longer a simple supply-and-demand business model," said David S. Hefner, Chief Executive Officer for Georgia Regents Medical Center. "Our goal is to foster an atmosphere of meaningful innovation that will have a significant and positive impact on the health of our patients."

"We are proud to embark on this transformational alliance with Georgia Regents Medical Center as we share the vision that we can create the future of health care by creatively and cost-effectively meeting the long-term needs of patients," said Deborah DiSanzo, chief executive officer, Philips Healthcare."

With more than 100 years of experience in health care, Philips' aim is to provide innovative solutions that address the complexities of health care delivery by working in close partnership with healthcare providers. The long term alliance with GRMC in the U.S. follows collaborations with hospitals in Europe, Asia, the Middle-east and Africa that have resulted in improved clinical operations and care delivery performance.

The owner of a medical clinic was arrested today on charges he fraudulently billed Medicaid for more than $300,000 for services never rendered, state investigators said.

Randall Ritch, 46, of DeLand, faces four criminal charges for the Medicaid fraud, which took place from 2009 to 2009, the state Attorney General's Office said today.

Ritch owns Lake County Preferred OBGYN and has a business address at 2766 Dora Ave. in Tavares. For three years, Ritch submitted more than 2,500 claims to the Florida Medicaid program for reimbursement for medical services, according to an arrest report.

However, none of those claims were valid, investigators said. He filed the claims using the name and Medicaid provider number of a doctor who no longer worked for his clinic and the services never actually took place, investigators said.

The physician contacted authorities that her Medicaid provider number was being falsely used in billing and that she would be responsible for any taxes for the Medicaid payments, according to an arrest report.

He faces two counts of Medicaid fraud, one count of criminal use of a personal identification number for using the doctor's Medicaid number, and one count of operation of an unlicensed health care clinic, because Lake County Preferred OBGYN didn't have a valid license from the Agency for Health Care Administration during the time the Medicaid claims were made, according to an arrest report.

Friday, June 28, 2013

PwC concludes Phase 1 of its Mobile Innovations Forecast, in which we have examined trends in the performance of core components of mobile devices and infrastructure. Based on new data for these components, our fundamental assessment is that the rate of performance increases for these seven enabling components of mobile innovation—memory, application processor, storage, infrastructure speed, device speed, imaging and display technology—is expected to decelerate only slightly between 2011 and 2016, relative to 2007 to 2011.

We do see a potential trouble spot with the coming introduction of ultra high definition (UHD) video. Will the massive data streams produced by UHD overwhelm the other components? We explore that issue in the article. On the other hand, we are enthused by the early breakthroughs demonstrated by smartphones that use contextual information to deliver new value to owners. And a major question as we move into Phase 2 of our exploration of mobile innovation is how many mobile operating systems (OS) and associated app store ecosystems will survive to relevancy by 2016?

Figure 5: Index component changes

This forecast exists within PwC’s framework for understanding various dynamics driving the broader technology sector today, a framework that suggests ways technology companies might navigate disruptions that are rich in opportunity.

Our coverage of the vast mobile ecosystem is an ongoing project comprising four phases. Phase 1 examined the performance improvements of existing technology components. Phase 2, launching soon, covers new capabilities being added to mobile devices. Phase 3 will review compelling new use cases. And Phase 4 will cover new business models.

To learn more about mobile innovation in the next few years, read or download the full article.

About a year and a half ago, Dr. Leslie Kernisan, 37, a geriatrician in San Francisco, decided she couldn’t stand her medical practice any longer. Every day, she felt she was shortchanging her older patients.

“What I had in the way of time and resources to meet patients’ needs was so inadequate that it felt almost grotesque,” she told me recently.

Dr. Leslie Kernisan

At the time, Dr. Kernisan was working at a community clinic filled with caring, committed professionals. They weren’t the problem. What was wrong, she felt, was a dysfunctional system of health care for seniors — and at the center of that was Medicare, the government’s insurance program for seniors.

Today, she spends as much time as her patients want reviewing their medical problems, their prognosis, how their care is being coordinated, and what caregivers can do to help. When people call for help, she calls them back within two hours. E-mails are answered in one business day; a request for a house call generates an appointment in no more than two days.

The price for all of this: $200 an hour, which patients pay out of their own pockets, for anything and everything she does. (Though Medicare doesn’t pay for her services, it does pay for medical tests and services provided to these patients by other physicians.)

Those fees are unaffordable for all but relatively well-off older adults, however. While people didn’t complain, Dr. Kernisan said she felt “terrible” about leaving patients who had relied on her and guilty toward colleagues who shouldered responsibilities she was giving up.

Still, she’d come to a breaking point, and it seemed impossible to go on as things were. “It was so stressful that I felt my own health and well-being were suffering,” Dr. Kernisan said.

Dr. Kernisan described her new geriatrics practice recently in a Hastings Center blog post and spent several hours talking with me about her decision to leave Medicare. Hers is an extreme example of the malaise afflicting geriatricians.

“Maintaining practice in geriatrics is very difficult unless you have some other form of support,” like an academic position or a medical directorship at a nursing home, said Dr. Peter Hollmann, chairman of the public policy committee of the American Geriatrics Society. “It’s one of the only fields in medicine where additional years of training yields less compensation, not more.”

At doctors’ offices and at the clinic where Dr. Kernisan worked, Medicare paid only for face-to-face visits, not phone calls or consultations with family members; reimbursements didn’t even begin to cover the effort required for thorough medical evaluations of medically complex patients. The only way to stay afloat financially, she found, was to pack in patients back-to-back in 15- to 30-minute slots.

“People would come in with a long list of concerns that they wanted to address, and you’re thinking, ‘How many of these can I follow up on?” Dr. Kernisan said. “And you ended up having to pick just two or three. If you’re conscientious, it’s distressing to feel you can’t do most of what you should be doing.”

Stressed and unable to sleep at night, the young doctor felt pulled between her professional passion for helping older patients and their families and her personal life, with the abundant demands of two small children.

One day, her 3-year-old asked, “Mommy, why are you always mad and always saying no?” At that point, Dr. Kernisan said, she was forced to recognize she was “always cranky at home and miserable going to work.” It was time for a change. In May 2012, she left the clinic where she’d worked part time as a medical director, and in October she opened her own practice.

That move coincides with a growing debate within her profession. Given the small numbers of geriatricians in the United States, should they even try to provide basic medical care? Or should they become consultants, called in on complex cases that require special expertise in the health concerns of older adults?

“A lot of geriatricians feel they might use their time more effectively working in teams with primary care physicians,” said Dr. Gregg Warshaw, a professor of family medicine and geriatrics at the University of Cincinnati.

Today, Dr. Kernisan describes herself as a coach and a consultant. Instead of delivering routine medical care, she conducts comprehensive, specialized geriatric assessments, evaluates care ordered by other doctors, and comes up with plans to fill gaps in care that other medical professionals haven’t addressed.

“I focus on things like pain, physical decline, falls, incontinence, frailty, the management of medical complexity — things that tend to be missed by primary care doctors who lack the time or expertise or both,” she said.

Sometimes, it’s not easy. Though Dr. Kernisan tries to work closely with a patient’s primary care doctor, some haven’t welcomed her input. “It’s a delicate issue,” she said. “The vast majority of the time, it has been a family or a geriatric care manager who calls me up, not a primary care doctor saying, ‘I need help with this older person.’”

Dr. Hollmann said, “I think it is a reasonable option for some number of geriatricians to have this kind of practice, but hopefully it won’t be too many, because we want Medicare patients to have access to care.”

Although there’s a lot of noise about physicians’ unhappiness with Medicare and some evidence of doctors restricting the number of Medicare members they’ll treat, only 3,423 physicians nationwide opted out of the government health program last year, according to the Centers for Medicare and Medicaid Services.

But those numbers aren’t necessarily reliable. When the Office of the Inspector General of the Department of Health and Human Services was asked to evaluate how many physicians were opting out of Medicare, it found that the Centers for Medicare and Medicaid Services and the agency’s contracts were not maintaining “sufficient data” to answer the question.

If you know of other geriatricians who’ve exited Medicare and set up new models of practice for older adults, tell us more in the comments section.

A key U.S. senator sent letters to all 50 states this week asking how they sanction doctors in their state health programs and whether they alert the federal government when they do.

In his letters, Sen. Charles Grassley, R-Iowa, cited examples from a ProPublica report last month that found doctors who had been kicked out of state Medicaid programs for the poor were able to continue prescribing drugs to elderly and disabled patients in Medicare.

In 2005, for example, Florida booted Dr. Enrique Casuso from its Medicaid network using a provision that allows it to end contracts without cause on 30 days' notice. A memo justifying his removal said Casuso was seeing up to 81 Medicaid patients a day in addition to his non-Medicaid cases. Investigators found cases in which he lacked "awareness or oversight of the medication prescribed."

A copy of Casuso's termination letter was sent to Medicare. But Casuso continues to prescribe in Medicare's drug program, known as Part D, ProPublica reported.

In 2010, he prescribed more antipsychotics to elderly patients – 8,900, including refills dispensed – than any other doctor in the country. Many of those went to patients with dementia even though warnings from the Food and Drug Administration say the drugs increase the risk of death in such patients.

Casuso defended his prescribing, telling ProPublica the drugs were necessary to keep his patients safe and to calm them.

Physicians can be terminated from Medicaid for a variety of reasons. If they are terminated with cause, the state must prove misconduct. A termination without cause doesn't require any burden of proof. It may be because a doctor has stopped seeing Medicaid patients or because it is a quicker way of severing ties with a doctor suspected of wrongdoing.

The concern, Grassley wrote, is that while states use "without cause" terminations to quickly remove doctors from their Medicaid networks, the actions are not considered disciplinary and can't be used against doctors by Medicare. Terminations with cause, which are formal sanctions, can take much longer because they can be appealed.

"States' current practice of without cause termination from Medicaid may speed their ability to protect Medicaid patients, but it can expose Medicare recipients to potentially unsafe medical treatment and keeps tax dollars flowing to unworthy providers," wrote Grassley, the ranking Republican on the Senate Judiciary Committee.

Medicaid is jointly funded by states and the federal government, but is run by the states. Medicare is run by the federal government.

Grassley asked each state Medicaid program to indicate how it determines when to use the "without cause" provision and how it informs Medicare of its actions, if at all. Once states respond, Grassley plans to ask Medicare whether and how it acts on this information.

Physicians can continue to prescribe in Medicare unless they have been formally excluded from the program.

This is not the first time Grassley has questioned how Medicaid monitors prescribing by physicians and others. In 2010, he sent letters to all states asking for the names of the top prescribers of painkillers, antianxiety drugs and antipsychotics in their Medicaid programs. He followed up last year to ask whether the states had cracked down on those who wrote large numbers of prescriptions.

The senator also has focused on doctors' ties to drug companies. He was a key proponent of the Physician Payment Sunshine Act, which requires all drug and medical device makers to make public their payments to doctors beginning next year. And in 2009, he sent letters to prominent medical organizations seeking details about their industry financial support.

Justin Senior, the deputy secretary of Florida's Agency for Health Care Administration, said earlier this year that the ability to terminate a doctor's Medicaid contract without cause is "a tool that we can use when we see someone we feel might be doing something that is inappropriate."

In Florida, if physicians are expelled for cause from Medicaid, they cannot renew their state medical licenses. This can make the legal battle over such a termination much fiercer.

But Senior said that the physicians who are removed without cause have no blemish on their record. "They still have a license to practice medicine," he said. "They can happily make a living billing Medicare, Blue Cross ... billing whoever is willing to do business them."

Medicare could use these cases as tips to pass onto its own fraud investigators.

In his letter, Grassley cited two other examples from ProPublica's report:

Chicago psychiatrist Michael Reinstein wrote an average of 20,000 prescriptions for the antipsychotic clozapine in Part D each year between 2007 and 2009, and another 14,000 in 2010. Last year, he was suspended from Illinois Medicaid, and the Department of Justice has sued him for fraud. But he remains able to provide services under Medicare. Reinstein has treated patients at more than 30 Chicago-area nursing homes and long-term care facilities. He has defended his prescribing in media interviews.

Miami psychiatrist Fernando Mendez-Villamil was terminated without cause from Florida Medicaid in 2010 amid questions about his prescribing of mental health drugs. The Florida medical board also has accused him of giving patients as young as 3 a variety of such drugs without properly diagnosing or monitoring them. He remains eligible to prescribe in Medicare. His lawyer has said his client had done nothing wrong.

The Centers for Medicare and Medicaid Services, which oversees both programs, did not respond to a request for comment. Officials have previously declined to comment on the physicians named in this story.

In a statement, Grassley said he wants to "get first-hand information" to make sure actions taken by Medicaid programs don't leave Medicare patients at risk.

This Notice document was issued by the Centers for Medicare
Medicaid Services (CMS)

Summary

The Centers for Medicare & Medicaid Services (CMS) is
announcing an opportunity for the public to comment on CMS' intention to
collect information from the public. Under the Paperwork Reduction Act of 1995
(PRA), federal agencies are required to publish notice in theFederal
Registerconcerning each proposed collection of information (including each
proposed extension or reinstatement of an existing collection of information)
and to allow 60 days for public comment on the proposed action. Interested
persons are invited to send comments regarding our burden estimates or any
other aspect of this collection of information, including any of the following
subjects: (1) The necessity and utility of the proposed information collection
for the proper performance of the agency's functions; (2) the accuracy of the
estimated burden; (3) ways to enhance the quality, utility, and clarity of the
information to be collected; and (4) the use of automated collection techniques
or other forms of information technology to minimize the information collection
burden.

Dates

Comments must be received by August 27, 2013:

Addresses

When commenting, please reference the document identifier or
OMB control number (OCN). To be assured consideration, comments and
recommendations must be submitted in any one of the following ways:

1. Electronically. You may send your comments electronically
to http://www.regulations.gov. Follow the instructions for “Comment or
Submission” or “More Search Options” to find the information collection
document(s) that are accepting comments.

2. By regular mail. You may mail written comments to the
following address: CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development, Attention: Document Identifier/OMB Control
Number ___ Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland
21244-1850.

To obtain copies of a supporting statement and any related
forms for the proposed collection(s) summarized in this notice, you may make
your request using one of following:

This notice sets out a summary of the use and burden
associated with the following information collections. More detailed
information can be found in each collection's supporting statement and
associated materials (seeADDRESSES).

CMS-10199Data Collection for Medicare Facilities Performing
Carotid Artery Stenting with Embolic Protection in Patients at High Risk for
Carotid Endarterectomy

Under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C.
3501-3520), federal agencies must obtain approval from the Office of Management
and Budget (OMB) for each collection of information they conduct or sponsor.
The term “collection of information” is defined in 44 U.S.C. 3502(3) and 5 CFR
1320.3(c) and includes agency requests or requirements that members of the
public submit reports, keep records, or provide information to a third party.
Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day
notice in theFederal Registerconcerning each proposed collection of
information, including each proposed extension or reinstatement of an existing
collection of information, before submitting the collection to OMB for
approval. To comply with this requirement, CMS is publishing this notice.

Information Collections

1. Type of Information Collection Request: Reinstatement
without change of a previously approved collection; Title of Information
Collection: Data Collection for Medicare Facilities Performing Carotid Artery
Stenting with Embolic Protection in Patients at High Risk for Carotid
Endarterectomy; Use: We provide coverage for carotid artery stenting (CAS) with
embolic protection for patients at high risk for carotid endarterectomy and who
also have symptomatic carotid artery stenosis between 50 percent and 70 percent
or have asymptomatic carotid artery stenosis ≥ 80 percent in accordance with
the Category B IDE clinical trials regulation (42 CFR 405.201), a trial under
the CMS Clinical Trial Policy (NCD Manual § 310.1, or in accordance with the
National Coverage Determination on CAS post approval studies (Medicare NCD
Manual 20.7).

Accordingly, we consider coverage for CAS reasonable and
necessary (section 1862(A)(1)(a) of the Social Security Act). However, evidence
for use of CAS with embolic protection for patients with high risk for carotid
endarterectomy and who also have symptomatic carotid artery stenosis ≥ 70
percent who are not enrolled in a study or trial is less compelling. To
encourage responsible and appropriate use of CAS with embolic protection, we
issued a Decision Memo for Carotid Artery Stenting on March 17, 2005,
indicating that CAS with embolic protection for symptomatic carotid artery
stenosis ≥ 70 percent will be covered only if performed in facilities that have
beendetermined to be competent in performing the evaluation, procedure and
follow-up necessary to ensure optimal patient outcomes. In accordance with this
criteria, we consider coverage for CAS reasonable and necessary (section
1862(A)(1)(a) of the Social Security Act). Form Number: CMS-10199 (OCN:
0938-1011); Frequency: Yearly; Affected Public: Business or other for-profit,
Not-for-profit institutions; Number of Respondents: 1,000; Total Annual
Responses: 1,000; Total Annual Hours: 500. (For policy questions regarding this
collection contact Lori Ashby at 410-786-6322.)

2. Type of Information Collection Request: New Collection
(Request for a new OMB control number); Title of Information Collection: End
Stage Renal Disease (ESRD) Application Access Request Form; Use: We are
developing a new suite of systems to support the End Stage Renal Disease (ESRD)
program. Due to the sensitivity of the data being collected and reported, we
must ensure that only authorized personnel have access to data. Personnel are
given access to the ESRD systems through the creation of user IDs and passwords
within the QualityNet Identity Management System (QIMS); however, once within
the system, the system determines the rights and privileges the personnel has
over the data within the system. Such access rights include: Viewing and
reporting, updating adding and deleting.

The sole purpose of the ESRD Application Access Request Form
is to identify the individual's data access rights once within the ESRD system.
This data collection is currently being accomplished under “Part B” of the
QualityNet Identity Management System Account Form. Once the ESRD Application
Access Form is approved, the QualityNet Identity Management System (QIMS)
Account Form will be revised to remove Part B from the QIMS data collection.
The ESRD Application Access Request Form will be a new form and will be
assigned its own OMB Control number. The ESRD system accounts created using the
current QIMS Account Form—Part B will not need to submit an ESRD Application
Access Form for the creation of their account since that information was
collected under Part B.

The QIMS Account Registration and the ESRD Application
Access Request forms are required for identity and security management of
individuals accessing the Consolidated Renal Operations in a Web Enabled
Network (CROWNWeb) system and the End Stage Renal Disease Quality Incentive
Program (ESRD QIP) system. The CROWNWeb system is the system that is mandated
for the Medicare and Medicaid Programs Conditions of Coverage for End-Stage
Renal Disease Facilities, Final Rule published April 15, 2008. Form Number:
CMS-10484 (OCN: 0938-NEW); Frequency: Annually; Affected Public: Business and
other for-profits; and not-for-profits; Number of Respondents: 27,000; Total
Annual Responses: 27,000; Total Annual Hours: 6,750. (For policy questions
regarding this collection contact Victoria Schlining at 410-786-6878.)

3. Type of Information Collection Request: Reinstatement
with change of a currently approved collection; Title of Information
Collection: Conditions of Certification for Rural Health Clinics; Use: The
Rural Health Clinic (RHC) conditions of certification are based on criteria prescribed
in law and are designed to ensure that each facility has a properly trained
staff to provide appropriate care and to assure a safe physical environment for
patients. We use these conditions of participation to certify RHCs wishing to
participate in the Medicare program. These requirements are similar in intent
to standards developed by industry organizations such as the Joint Commission
on Accreditation of Hospitals, and the National League of Nursing and the
American Public Association and merely reflect accepted standards of management
and care to which rural health clinics must adhere. Form Number: CMS-R-38 (OCN:
0938-0334); Frequency: Recordkeeping and Reporting—Annually; Affected Public:
Business or other for-profits; Number of Respondents: 9,716; Total Annual
Responses: 9,716; Total Annual Hours: 33,304. (For policy questions regarding
this collection contact Mary Collins at 410-786-3189.)

4. Type of Information Collection Request: Reinstatement
with change of a currently approved collection; Title of Information
Collection: Conditions of Participation: Requirements for Approval and
Reapproval of Transplant Centers to Perform Organ Transplants; Use: The
Conditions of Participation and accompanying requirements specified in the
regulations are used by our surveyors as a basis for determining whether a
transplant center qualifies for approval or re-approval under Medicare. We,
along with the healthcare industry, believe that the availability to the
facility of the type of records and general content of records is standard
medical practice and is necessary in order to ensure the well-being and safety
of patients and professional treatment accountability. Form Number: CMS-10266
(OCN: 0938-1069); Frequency: Yearly; Affected Public: Business or other for-profits
and Not-for-profit institutions; Number of Respondents: 226; Total Annual
Responses: 528; Total Annual Hours: 2,523. (For policy questions regarding this
collection contact Diane Corning at 410-786-8486.)

5. Type of Information Collection Request: Revision of a
currently approved collection; Title of Information Collection: Part C—Medicare
Advantage and 1876 Cost Plan Expansion Application; Use: Organizations wishing
to provide healthcare services under Medicare Advantage (MA) and/or MA
organizations that offer integrated prescription drug and health care products
must complete an application, file a bid, and receive final approval from us.
Existing MA plans may request to expand their contracted service area by
completing the Service Area Expansion application. Any current 1876 Cost Plan
Contractor that wants to expand its Medicare cost-based contract with CMS can
complete the application. Information is collected to ensure applicant
compliance with our requirements and to gather data used to support its
determination of contract awards. Form Number: CMS-10237 (OCN 0938-0935);
Frequency: Yearly; Affected Public: Business or other for-profits and
Not-for-profits institutions; Number of Respondents: 566; Total Annual
Responses: 566; Total Annual Hours: 22,955. (For policy questions regarding
this collection contact Melissa Staud at 410-786-3669.)

6. Type of Information Collection Request: Reinstatement
without change of a previously approved collection; Title of Information
Collection: Creditable Coverage Disclosure to CMS On-Line Form and
Instructions; Use: Most entities that currently provide prescription drug
benefits to any Medicare Part D eligible individual must disclose whether their
prescription drug benefit is creditable (expected to pay at least as much, on
average, as the standard prescription drug plan under Medicare). The disclosure
must be provided annually and upon any change that affects whether the coverage
is creditable prescription drug coverage. Form Number: CMS-10198 (OCN:
0938-1013). Frequency: Yearly and semi-annually; Affected Public: Business or
other for-profits and not-for-profit institutions, State, Local, or Tribal
Governments. Number of Respondents: 85,610; Total Annual Responses: 87,265;
Total Annual Hours: 7,272. (For policy questions regarding thiscollection
contact Roslyn Thomas at 410-786-9621.)

7. Type of Information Collection Request: Extension without
change of a currently approved collection; Title of Information Collection:
Medicare Advantage Program Requirements; Use: Medicare Advantage (MA)
organizations and potential MA organizations (applicants) use the information
to comply with the application requirements and the MA contract requirements.
We will use this information to: Approve contract applications, monitor compliance
with contract requirements, make proper payment to MA organizations, determine
compliance with the new prescription drug benefit requirements, and to ensure
that correct information is disclosed to Medicare beneficiaries (both potential
enrollees and enrollees). Form Number: CMS-R-267 (OCN: 0938-0753). Frequency:
Yearly. Affected Public: Individuals or households and Business or other
for-profits; Number of Respondents: 18,043,776; Total Annual Responses:
21,935,728; Total Annual Hours: 8,529,541. (For policy questions regarding this
collection contact Dana Burley at 410-786-4547.)

8. Type of Information Collection Request: Revision of a
currently approved collection; Title of Information Collection: Solicitation
for Applications for Medicare Prescription Drug Plan 2015 Contracts; Use: The
information will be collected under the solicitation of proposals from
prescription drug plans, Medicare Advantage (MA) plans that offer integrated
prescription drug and health care coverage, Cost Plans, PACE, and EGWP
applicants. We will use the information collected to ensure that applicants
meet our requirements and to support the determination of contract awards. Form
Number: CMS-10137 (OCN: 0938-0936); Frequency: Yearly; Affected Public:
Business or other for-profits and Not-for-profits institutions; Number of
Respondents: 254; Total Annual Responses: 254; Total Annual Hours: 2,319. (For
policy questions regarding this collection contact Linda Anders at
410-786-0459.)

9. Type of Information Collection Request: Reinstatement
without change of a previously approved collection; Title of Information
Collection: Application for Hospital Insurance Benefits for Individuals with
End Stage Renal Disease; Use: The CMS-43 application is used (in conjunction
with CMS-2728) to establish entitlement to, and enrollment in, Medicare Part A
(and Part B) for individuals with end stage renal disease. The application is
completed by a Social Security Administration (SSA) claims representative or
field representative using information provided by the individual during an
interview. The CMS-43 application follows the questions and requirements used
by SSA to determine Title II eligibility. This is done not only for consistency
purposes, but because certain Title II and Title XVIII insured status and
relationship requirements must be met in order to qualify for Medicare under
the end stage renal disease provisions. Form Number: CMS-43 (OCN: 0938-0800);
Frequency: Once; Affected Public: Individuals or households; Number of
Respondents: 60,000; Total Annual Responses: 60,000; Total Annual Hours:
24,960. (For policy questions regarding this collection contact Lindsay Smith
at 410-786-6843.)

10. Type of Information Collection Request: Reinstatement
without change of a previously approved collection; Title of Information
Collection: Request for Termination of Premium Hospital and Supplementary
Medical Insurance; Use: The CMS-1763 provides us and the Social Security
Administration (SSA) with the enrollee's request for termination of Part B,
Part A or both Part B and A premium coverage. The form is completed by an SSA
claims or field representative using information provided by the Medicare
enrollee during an interview. The purpose of the form is to provide to the
enrollee with a standardized format to request termination of Part B, Part A
premium coverage or both, explain why the enrollee wishes to terminate such
coverage, and to acknowledge that the ramifications of the decision are
understood. Form Number: CMS-1763 (OCN: 0938-0025); Frequency: Once; Affected
Public: Individuals or households; Number of Respondents: 14,000; Total Annual
Responses: 14,000; Total Annual Hours: 5,833. (For policy questions regarding
this collection contact Lindsay Smith at 410-786-6843.)

11. Type of Information Collection Request: Extension
without change of a currently approved collection; Title of Information
Collection: Home Health Agency Cost Report; Use: In accordance with sections
1815(a), 1833(e) and 1861(v)(1)(A) of the Social Security Act, providers of
service in the Medicare program are required to submit annual information to
achieve reimbursement for health care services rendered to Medicare
beneficiaries. In addition, 42 CFR 413.20(b) requires that cost reports are
required from providers on an annual basis. Such cost reports are required to
be filed with the provider's Medicare contractor. The Medicare contractor uses
the cost report not only to make settlement with the provider for the fiscal
period covered by the cost report, but also in deciding whether to audit the
records of the provider. Section 413.24(a) requires providers receiving payment
on the basis of reimbursable cost provide adequate cost data based on their
financial and statistical records that must be capable of verification by
qualified auditors. Besides determining program reimbursement, the data
submitted on the cost reports supports the management of federal programs. The
data is extracted from the cost report and used for making projections of
Medicare Trust Fund requirements and for analysis to rebase home health agency
prospective payment system. The data is also available to Congress,
researchers, universities, and other interested parties. While the collection
of data is a secondary function of the cost report, its primary function is to
reimburse providers for services rendered to program beneficiaries. Form
Number: CMS-1728-94 (OCN: 0938-0022): Frequency: Yearly; Affected Public:
Business or other for-profits and Not-for-profit institutions; Number of
Respondents: 11,563; Total Annual Responses: 11,563; Total Annual Hours:
2,613,238. (For policy questions regarding this collection contact Angela
Havrilla at 410-786-4516.)

12. Type of Information Collection Request: Reinstatement
without change of a previously approved collection; Title of Information
Collection: Collection of Prescription Drug Event Data from Contracted Part D
Providers for Payment; Use: The information users for this information
collection request include Pharmacy Benefit Managers, third party
administrators and pharmacies and prescription drug plans, Medicare Advantage
plans that offer integrated prescription drug and health care coverage,
Fallbacks and other plans that offer coverage of outpatient prescription drugs
under the Medicare Part D benefit to Medicare beneficiaries. The data is used
primarily for payment, but is also used for claim validation as well as for
other legislated functions such as quality monitoring, program integrity, and
oversight. Form Number: CMS-10174 (OCN: 0938-0982); Frequency: Monthly; Affected
Public: Business or other for-profits and Not-for-profit institutions; Number
of Respondents: 747; Total Annual Responses: 947,881,770; Total Annual Hours:
1,896. (For policy questions regarding this collection contact Ivan Iveljic at
410-786-3312.)

13. Type of Information Collection Request: Revision of a
currently approved collection; Title of Information Collection: Part C Medicare
Advantage Reporting Requirements and Supporting Regulations; Use: There are a
number of information users of Part C reporting, including central and regional
office staff that use this information to monitor health plans and to hold them
accountable for their performance. Other government agencies such as the
Government Accountability Office have inquired about this information. Health
plans can use this information to measure and benchmark their performance. CMS
intends to make some of these data available for public reporting as “display
measures” in 2013. Form Number: CMS-10305 (OCN: 0938-1115); Frequency: Yearly
and semi-annually; Affected Public: Business or other for-profits; Number of
Respondents: 588; Total Annual Responses: 6,715; Total Annual Hours: 200,918.
(For policy questions regarding this collection contact Terry Lied at
410-786-8973.)

14. Type of Information Collection Request: New Collection
(Request for a new OMB control number; Title of Information Collection:
Enrollee Satisfaction Survey Data Collection; Use: Section 1311(c)(4) of the
Affordable Care Act (ACA) requires the Department of Health and Human Services
(HHS) to develop an enrollee satisfaction survey system that assesses consumer
experience with qualified health plans (QHPs) offered through an Exchange. It
also requires public display of enrollee satisfaction information by the
Exchange to allow individuals to easily compare enrollee satisfaction levels
between comparable plans. HHS intends to establish an enrollee satisfaction
survey system that assesses consumer experience with the Marketplaces and the
qualified health plans (QHPs) offered through the Marketplaces. The surveys
will include topics to assess consumer experience with the Marketplace such as
enrollment and customer service, as well as experience with the health care
system such as communication skills of providers and ease of access to health
care services. We are considering using the Consumer Assessment of Health
Providers and Systems (CAHPS®) principles (http://www.cahps.ahrq.gov/about.htm)
for developing the surveys. We are also considering an application and approval
process for enrollee satisfaction survey vendors who want to participate in
collecting ESS data. The application form for survey vendors includes
information regarding organization name and contact(s) as well as minimum
business requirements such as relevant survey experience, organizational survey
capacity, and quality control procedures.

The Marketplace Survey will provide (1) actionable
information that the Marketplaces can use to improve performance, (2)
information that we and state regulatory organizations can use for oversight,
and (3) a longitudinal database for future Marketplace research. The CAHPS®
family of instruments does not have a survey that assesses entities similar to
Marketplaces, so the Marketplace survey items were generated by the project
team. The QHP survey will (1) help consumers choose among competing health
plans, (2) provide actionable information that the QHPs can use to improve
performance, (3) provide information that regulatory and accreditation
organizations can use to regulate and accredit plans, and (4) provide a
longitudinal database for consumer research. CMS plans to base the QHP survey
on the CAHPS® Health Plan Survey.

We are planning for two rounds of developmental testing for
the Marketplace and QHP surveys. The 2014 survey field tests will help
determine psychometric properties and provide an initial measure of performance
for Marketplaces and QHPs to use for quality improvement. Based on field test
results, there will be further refinement of the questionnaires and sampling
designs to conduct the 2015 beta test of each survey. We plan to request
clearance for two additional rounds of national implementation with public
reporting of scores for each survey in the future. A summary of findings from
the testing rounds will be included when requesting clearance for the
additional two rounds of national implementation with public reporting, which
will take place in 2016 and 2017. Form Number: CMS-10488 (OCN: 0938-NEW);
Frequency: Annually; Affected Public: Individuals and Households, Business or
other for-profits and Not-for-profit institutions; Number of Respondents:
251,671; Total Annual Responses: 251,671; Total Annual Hours: 86,014. (For
policy questions regarding this collection contact Kathleen Jack at
410-786-7214.)